緊急呼吸道處置的觀念更新

Emergent Airway Management: an Update

林重甫(Chung-Fu Lin) ； 謝宗達(Cong-Tat Cia)

《內科學誌》 34卷1期 (2023/02) Pp. 17-31

https://doi.org/10.6314/JIMT.202302_34(1).05

摘要

內科病患時常需要接受緊急呼吸道處置，且這些病患的病況較不穩定，讓氣道處理困難度倍增，進而造成併發症和死亡率上升。人為因素、技術、設備和環境等皆會影響插管成功率，需要透過適當訓練、團隊運作和妥善的插管前規劃（包含插管失敗時的備用方案）來避免併發症發生。插管前給氧建議使用面罩通氣（face mask ventilation）合併高流量鼻導管（high flow nasal cannula）；插管時亦可考慮使用影像喉頭鏡（video laryngoscope）和bougie插管導引管。若插管失敗，可嘗試使用面罩（face mask）或聲門上呼吸道（supraglottic airway）進行通氣；若仍無法改善病患氧合，則要盡快進行頸前氣道建立（front-of-neck airway）。插管前後也要密切監測病患生命象徵、並謹慎維持建立好的呼吸道，以避免併發症發生。

關鍵字

緊急呼吸道處置（emergent airway management） ； 氣管插管（endotracheal intubaiton） ； 喉頭鏡（laryngoscope） ； 聲門上呼吸道（supraglottic airway）

並列摘要

Medical patients need emergent airway management sometimes. The clinical instability leads to "physiologically" difficult airway and subsequent morbidity and mortality. Human factors, technique, devices, and environment all contribute to successful airway management. Adequate training, team working, and pre-procedural planning including rescue interventions may prevent complications. Optimal preoxygenation could be achieved by applying mask ventilation and high-flow nasal cannula. Video laryngoscope and bougie may facilitate endotracheal intubation. When intubation attempts fail, face mask ventilation or supraglottic airway are alternatives to maintain oxygenation. A front-of-neck airway should be performed when 'can't intubate, can't oxygenate' situation occurs. Meticulous peri-intubation care including intensive hemodynamic monitoring and adequate positioning and maintenance of the established airway is essential to prevent complications.